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Cynical title: Change with questionable benefit extends patent life and thus prices of insulin even further. To be clear: I don't know a lot about insulin. I'm

by cletus 5y ago

Cynical title: Change with questionable benefit extends patent life and thus prices of insulin even further. To be clear: I don't know a lot about insulin. I'm fortunate enough not to be diabetic. So there may have been useful advancements in insulin. The price of insulin in the US does seem to be awfully high however. It is a common practice for pharmaceutical companies to alter the active molecule in some way, claim the new version has benefits, reset the patent timeline and stop producing the old version. EDIT: in case it wasn't clear, if this is actually good for diabetics, that's fantastic. Insulin in the US shouldn't be as expensive as it is. I'm just seen too much profiteering (eg Epipen) by that industry.

_Microft 5y ago
I am not a biologist but the proposed behavior of the molecule seems highly beneficial for the patient. It is supposed to only activate in presence of enough glucose instead of always. This is meant to prevent dangerously low blood sugar. They only conducted experiments with fructose so far.
Trasmatta 5y ago
I am T1 diabetic, and this change, if it works, could absolutely be a game changer. > So there may have been useful advancements in insulin There have been massive advancements in insulin over the past couple of decades. Today's long acting and short acting insulins are a massive improvement over the older kinds. The price of insulin in the US is a disaster (when not covered by insurance), but otherwise the quality of insulin treatment is better than it's ever been.
- randcraw 5y ago
  I'm a T2 diabetic, and though I don't (yet) take insulin, I'm pretty sure this could be a very big win for other T2s who do. Dosing insulin is clumsy with an insulin pump, and always hit-or-miss without one (insulin arrives too early or too late or in the wrong amount). The adaptive release of insulin only when glucose levels rise could provide a near-ideal therapy for millions. If it's affordable...
jcims 5y ago
I'm not an expert, but have a lot of exposure to this through my kiddo who is a type-1 (insulin deficient) diabetic. This could represent a step function change in her therapy. Only for folks using the latest and greatest in closed-loop pump therapy is there even an approximation of the pancreas function to elevate insulin levels in response to elevated blood glucose levels, and even then its too slow to be effective. Diabetics that want to closely manage their blood glucose levels have to carefully plan how they eat and how active they are, modulo sickness, periods/etc. If it was possible to have a latent insulin bolus floating around the bloodstream that could react to gluecose directly, it could provide an important buffer and possibly even a wonderfully passive approach to therapy vs. the ridiculous dance that patients undergo today.
Someone 5y ago
If patents were a significant factor in the high prices for insulin in the USA, you would expect prices to be similarly high in all countries that recognize those patents. They aren’t. https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html: “Although the ratio of U.S. to other-country prices varied depending on the comparison country and insulin category, U.S. prices were always higher (often five to ten times higher) than those in other countries.“ “Other countries” includes Canada and Germany, so they didn’t look at particularly poor countries. The linked PDF says “The average U.S. manufacturer price per standard unit across all insulins was $98.70, compared with $6.94 in Australia, $12.00 in Canada, $7.52 in the United Kingdom, and $8.81 across all non-U.S. OECD countries combined”
- jellicle 5y ago
  All of those countries set how much they'll pay for insulin. They have price controls. The USA does the opposite; requires governmental medical insurance providers NOT to bargain with pharma companies and instead explicitly requires them to pay whatever price the pharma company sets. Low prices could come from either a) a robust, competitive market in producing and selling insulin or b) governmental price controls. The USA explicitly chooses not to have either. Other countries typically choose b) backed up by a threat of a) (if you're a pain in the ass over our negotiated price controls, we'll go source a large supply of insulin from somewhere else).
  - boublepop 5y ago
    > The USA does the opposite; requires governmental medical insurance providers NOT to bargain with pharma companies and instead explicitly requires them to pay whatever price the pharma company sets. That’s either a gross misunderstanding or deliberate misinformation. There is both price negotiations and significant rebates negotiated by pharmacy benefits managers who will often make 75% of the profit on the sale of the drugs back as rebates. They then distribute that back to insurers and other parties. Sadly those enormous rebates don’t seem to reach or benefit the patients.
    - 5y ago
hooande 5y ago
This comment is just wrong. This isn't a 'questionable benefit', it's a major change to the fundamental technology. This has nothing to do with price or profits at all. Comparing this theoretical advance to existing insulin is like comparing electric vehicles to gas powered cars. It's a difference in kind, not degree. To explain, currently your pancreas is measuring your blood sugar and producing more or less insulin to keep it at a safe level (let's call that level "100"). A type 1 diabetic has to do that process manually, measuring their blood sugar with a device and taking enough insulin via needle to keep it at 100. It's possible to overshoot and have blood sugar go far below 100, which can do real damage to cells that need sugar as an energy source. Obviously if you have to measure and adjust several times a day, every day, even a 1% human error rate is going to come up often. This theoretical insulin would stop working if there wasn't sufficient sugar already in the blood. As another comment said, it would basically stop working if your blood sugar was below 75 or 80. Right now diabetics are at risk from blood sugar being too high OR too low. This would cut out half of that risk, and be life changing for millions of people. Has nothing to do with price, and as always I must mention that generic insulin is abundant and readily available at low prices to anyone. I don't expect everyone to follow the details of insulin and having diabetes. But it would be nice if medical advancements could be discussed without people conflating the topics with their pet political issues.

by cletus 5y ago

_Microft 5y ago

I am not a biologist but the proposed behavior of the molecule seems highly beneficial for the patient. It is supposed to only activate in presence of enough glucose instead of always. This is meant to prevent dangerously low blood sugar. They only conducted experiments with fructose so far.

Trasmatta 5y ago

I am T1 diabetic, and this change, if it works, could absolutely be a game changer. > So there may have been useful advancements in insulin There have been massive advancements in insulin over the past couple of decades. Today's long acting and short acting insulins are a massive improvement over the older kinds. The price of insulin in the US is a disaster (when not covered by insurance), but otherwise the quality of insulin treatment is better than it's ever been.

randcraw 5y ago
I'm a T2 diabetic, and though I don't (yet) take insulin, I'm pretty sure this could be a very big win for other T2s who do. Dosing insulin is clumsy with an insulin pump, and always hit-or-miss without one (insulin arrives too early or too late or in the wrong amount). The adaptive release of insulin only when glucose levels rise could provide a near-ideal therapy for millions. If it's affordable...

jcims 5y ago

I'm not an expert, but have a lot of exposure to this through my kiddo who is a type-1 (insulin deficient) diabetic. This could represent a step function change in her therapy. Only for folks using the latest and greatest in closed-loop pump therapy is there even an approximation of the pancreas function to elevate insulin levels in response to elevated blood glucose levels, and even then its too slow to be effective. Diabetics that want to closely manage their blood glucose levels have to carefully plan how they eat and how active they are, modulo sickness, periods/etc. If it was possible to have a latent insulin bolus floating around the bloodstream that could react to gluecose directly, it could provide an important buffer and possibly even a wonderfully passive approach to therapy vs. the ridiculous dance that patients undergo today.

Someone 5y ago

If patents were a significant factor in the high prices for insulin in the USA, you would expect prices to be similarly high in all countries that recognize those patents. They aren’t. https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html: “Although the ratio of U.S. to other-country prices varied depending on the comparison country and insulin category, U.S. prices were always higher (often five to ten times higher) than those in other countries.“ “Other countries” includes Canada and Germany, so they didn’t look at particularly poor countries. The linked PDF says “The average U.S. manufacturer price per standard unit across all insulins was $98.70, compared with $6.94 in Australia, $12.00 in Canada, $7.52 in the United Kingdom, and $8.81 across all non-U.S. OECD countries combined”

jellicle 5y ago
All of those countries set how much they'll pay for insulin. They have price controls. The USA does the opposite; requires governmental medical insurance providers NOT to bargain with pharma companies and instead explicitly requires them to pay whatever price the pharma company sets. Low prices could come from either a) a robust, competitive market in producing and selling insulin or b) governmental price controls. The USA explicitly chooses not to have either. Other countries typically choose b) backed up by a threat of a) (if you're a pain in the ass over our negotiated price controls, we'll go source a large supply of insulin from somewhere else).
- boublepop 5y ago
  > The USA does the opposite; requires governmental medical insurance providers NOT to bargain with pharma companies and instead explicitly requires them to pay whatever price the pharma company sets. That’s either a gross misunderstanding or deliberate misinformation. There is both price negotiations and significant rebates negotiated by pharmacy benefits managers who will often make 75% of the profit on the sale of the drugs back as rebates. They then distribute that back to insurers and other parties. Sadly those enormous rebates don’t seem to reach or benefit the patients.
  - 5y ago

hooande 5y ago

This comment is just wrong. This isn't a 'questionable benefit', it's a major change to the fundamental technology. This has nothing to do with price or profits at all. Comparing this theoretical advance to existing insulin is like comparing electric vehicles to gas powered cars. It's a difference in kind, not degree. To explain, currently your pancreas is measuring your blood sugar and producing more or less insulin to keep it at a safe level (let's call that level "100"). A type 1 diabetic has to do that process manually, measuring their blood sugar with a device and taking enough insulin via needle to keep it at 100. It's possible to overshoot and have blood sugar go far below 100, which can do real damage to cells that need sugar as an energy source. Obviously if you have to measure and adjust several times a day, every day, even a 1% human error rate is going to come up often. This theoretical insulin would stop working if there wasn't sufficient sugar already in the blood. As another comment said, it would basically stop working if your blood sugar was below 75 or 80. Right now diabetics are at risk from blood sugar being too high OR too low. This would cut out half of that risk, and be life changing for millions of people. Has nothing to do with price, and as always I must mention that generic insulin is abundant and readily available at low prices to anyone. I don't expect everyone to follow the details of insulin and having diabetes. But it would be nice if medical advancements could be discussed without people conflating the topics with their pet political issues.